Provider Demographics
NPI:1598891228
Name:HO, VICTOR YEP (OD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:YEP
Last Name:HO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W MARCH LN STE 211
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6567
Mailing Address - Country:US
Mailing Address - Phone:209-272-7537
Mailing Address - Fax:209-272-7285
Practice Address - Street 1:3031 W MARCH LN STE 211
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6567
Practice Address - Country:US
Practice Address - Phone:209-272-7537
Practice Address - Fax:209-272-7285
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10589T152WC0802X, 152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0105890Medicaid
CAU63684Medicare UPIN
CASD0105891Medicare ID - Type Unspecified